Chronic anterior knee pain with a stable patella is often associated with overload and increased pressure on the lateral facet due to pathologic lateral soft-tissue restraints. "Lateral pressure in flexion" is a term describing the pathologic process of increasing contact pressure over the lateral patellar facet as knee flexion progresses. This report describes a surgical technique developed in response to lateral pressure in flexion and the shortcomings of traditional arthroscopic lateral release procedures. The technique is performed open with the knee in flexion, and the lateral release is repaired with a rotation flap of iliotibial band to close the defect and prevent patellar subluxation. The technique effectively decreases lateral patellar pressure and centers the patella correctly in the trochlear groove with minimal risk of iatrogenic patellar instability.

Medial patellar subluxation (MPS) is normally described after a lateral retinacular release. However, isolated MPS in the absence of a previous lateral release does occur. This type of patellar instability is often overlooked, and a high index of suspicion is needed for appropriate diagnosis and treatment. This report describes a technique developed in response to episodes of isolated MPS. The technique uses a partial-thickness graft from the quadriceps tendon to reconstruct the lateral patellofemoral ligament and provide stability to the lateral side of the patella. Medial patellar instability is a disabling condition that can limit daily functional activities because of apprehension and pain. The instability is influenced by a variety of factors that allow the patella to translate medially and ultimately subluxate or dislocate to the medial side. In patients with normal trochlear and patellar osseous anatomy and lower extremity alignment, the patellar instability results from insufficient passive soft-tissue stabilizers.

Medial patellar subluxation (MPS) is normally described following a lateral release. We report on a 14-year-old girl with MPS without previous lateral release. Arthroscopic examination demonstrated MPS at 0 and 30° of flexion, and the patella was tight in flexion on the lateral side. A low lateral release with a tibial tubercle transfer was performed, followed by repair of the lateral release with an iliotibial band flap, and lateral patellofemoral ligament reconstruction. Excellent functional outcome was achieved. This type of patellar instability is often overlooked and a high index of suspicion is needed for appropriate diagnosis and treatment.